Amit Mehta, MD, a third-year gastroenterology fellow at New York-Presbyterian/Weill Cornell Medical Center, has a clear career goal in mind. "I'm hoping to focus on endobariatrics," he said, referring to relatively new procedures that promote weight loss via endoscopy, such as endoscopic sleeve gastroplasty.
His more immediate goal, however, is to pass the American Board of Obesity Medicine (ABOM) certification exam and become an obesity medicine specialist. He and about 1400 other physicians are scheduled to take the 1-day exam during the February 18-25 testing period at computer-based testing centers in the United States and Canada and through live remote proctoring. Becoming certified, Mehta says, will help him better understand obesity and offer his patients more comprehensive treatment.
This year's pool of applicants hoping to become diplomates of the ABOM is 40% higher than last year and the greatest number taking the exam to date. And that's just the beginning, says John Cleek, MD, ABOM's board chairman and medical director of obesity medicine at Roper St. Francis Physician Partners in Charleston, South Carolina.
In 2012, the first year ABOM conferred certification, 224 physicians became diplomates. Currently, 4152 physicians are certified by ABOM. If all of the 2021 applicants pass, it will bring the number of physicians certified in obesity medicine to more than 5500 in the United States and Canada, Cleek notes. Last year, 85.3% of those taking the test passed on the first try.
"I think we are going to keep growing, in part because the obesity problem continues to grow," Cleek observed. "It's not like we are getting better at this."
Overall, 42.4% of the US population now have obesity, according to the Centers for Disease Control and Prevention, and among adults diagnosed with type 2 diabetes, 89% are overweight. Among children and teens ages 2-19, the prevalence of obesity is 18.5%.
Internists make up the largest percentage of obesity-certified physicians — 1512 are diplomates — followed by family medicine at 1201, endocrinology at 262, and pediatrics at 260.
Other Factors Behind the Growth
Besides the growing number of patients who have obesity, Cleek and other experts say several additional factors, which follow, help explain the increased interest in obesity medicine.
The COVID-19 pandemic: "The pandemic has made weight gain easier," Cleek noted, citing observations of his patients and their conversations. "They have a lot more access to food, and there is no walking to work [for many]." The pandemic-related anxiety doesn't help, he added. "Some deal with their emotions by eating."
Enlightened physician attitudes: "Back in the 60s and 70s, it was considered a failure of willpower to be obese," Cleek said. "Now there is so much more information. It's more acceptable to work with people rather than just say, 'Quit bending your elbow so much.'''
The American Medical Association recognized obesity as a disease in 2013. And in March 2020, Nature Medicine published a joint international consensus statement, signed by more than 100 professional societies, including the American Diabetes Association, the American Association of Clinical Endocrinologists, and others. They pledged to eliminate weight bias and the stigma of obesity.
Better understanding of obesity: "As the science of body weight regulation and obesity became clearer, physicians began to understand that body weight isn't just calories in, calories out...it's much more complex," said Rekha Kumar, MD, medical director of the ABOM and associate professor of clinical medicine at New York-Presbyterian/Weill Cornell Medical Center.
"We are not only seeing more physicians, but more younger physicians wanting to do this," she said of the obesity training and certification. It's likely younger physicians have needed to help patients more with weight loss management during training, she explained.
More options for treatments: As understanding has increased, treatment options have gone far beyond diet and exercise, with medications and bariatric surgery making it possible to tailor treatments to the individual.
Heightened awareness that patients need more help: Janice P. Miller, MD, is a board-certified internist who works as a primary care provider at Legacy Medical Group in Portland, Oregon. About 5 years ago, she became more interested in how best to treat obesity, as at least half of her patients are overweight or have obesity.
About 2 years ago, she completed a continuing medical education (CME) session on the Endocrine Society guidelines on obesity. She remembers thinking: 'There really is increased understanding [of obesity].'"
That led her to an obesity conference and the realization that she needed more information to treat her patients with weight issues more successfully. She took the ABOM exam in 2020 and is now a diplomate.
"I think it's improved the care of my patients and helped me explain to them why they are in this situation." Some end up crying, she said, when she explains the many factors contributing to obesity, and tell her they can begin to stop thinking of themselves as failures.
Janelle Potts, MD, board certified in family medicine, has practiced for 18 years in Rogers, Arkansas, and estimates at least half her patients deal with weight issues. "Year after year, I saw my patients struggling trying to lose weight. I wanted to get extra training, to be sure I was up to date on research, treatment, and surgery."
More on ABOM and Getting Certified
Certification as a diplomate of ABOM means the physician has specialized knowledge in the practice of obesity medicine and distinguishes the physician as "having achieved competency in obesity care."
ABOM was formed in 2011 through the cooperative efforts of the former American Board of Bariatric Medicine (ABBM) and the Certified Obesity Medicine Physician steering committee, with a goal of a single unified certification process. ABBM had been administering exams in obesity medicine since 1997.
To apply for the certification, a physician must have an active, unrestricted medical license, proof of active certification in a primary board (American Board of Medical Specialties [ABMS] or American Osteopathic Association equivalent), and proof of completion of a residency in the United States or Canada.
Applicants can then pursue one of two pathways, either by meeting CME requirements or fellowship requirements. The number of obesity fellowships is growing, but more are needed, Cleek said.
Currently, ABMS does not recognize obesity medicine as a specialty, he noted. In the future, "that would be an alternative or an option."
Predictions: Continued Growth, No Turf Wars
More gastroenterologists, cardiologists, and pediatricians will seek obesity medicine certification, Kumar predicts, joining internists, primary care physicians, and endocrinologists.
An increased income isn't a driving force for those seeking to become diplomates, Cleek says. The average salary of an obesity medicine physician is similar to that of a general internist or endocrinologist. At least right now, he notes, there's no income advantage to becoming an ABOM diplomate. And the fee for the application is $1500.
Often, a physician interested in obesity medicine has had personal weight struggles, or a family member has, said Cleek. "I grew up in 'Husky' clothes," he explained, noting his mother enrolled him in Weight Watchers as a child.
Potts, the Arkansas family practice physician, had weight loss surgery 6 years ago and shares that with her patients. "I feel like patients trust me more if they know I've struggled."
Many obesity specialists talk about the gratification of helping frustrated patients. In an ABOM video, Louis J. Aronne, MD, director of the Weill Cornell Center for Weight Management and Metabolic Clinical Research, summed it up this way: "We take people who have failed everything and we make them succeed."
As for a turf war brewing between internists or endocrinologists and those trained and certified in obesity medicine, Kumar says there's not a chance.
"Honestly, I feel like there can't be a turf war, because 40% of the country has obesity. There are patients everywhere to be treated."
Rather, working together will hopefully become the norm for physicians, Kumar said.
"I see it like diabetes. Every primary care provider knows how to do some [diabetes care]. When it gets complicated, they refer to an endocrinologist." She is hopeful the same will happen for obesity care.
"It's more of a collaboration than a turf war," Potts agreed.
Cleek, Mehta, Miller, and Potts have reported no relevant financial relationships. Kumar has reported being a speaker for Novo Nordisk and Janssen Pharmaceuticals, a consultant for Gelesis, Pfizer, and Eli Lilly, and a shareholder of Vivus.
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Cite this: COVID-19 Boosts Number of Docs Seeking Obesity Certification - Medscape - Feb 10, 2021.